Zusammenfassung
Valide Informationen aus größeren klinischen Studien über den sicheren Einsatz von Anästhetika und Analgetika während der Stillzeit sind so gut wie nicht vorhanden und beschränken sich oft auf Fallberichte oder Untersuchungen an kleinen Kollektiven. Angaben der Herstellerfirmen über die Verwendung der Medikamente sind aus haftungsrechtlichen Gründen restriktiv und häufig mit Gegenanzeige oder Kontraindikation für die Stillzeit versehen. Trotz fehlender Zulassung müssen diese Medikamente gleichwohl täglich bei stillenden Müttern eingesetzt werden. Der vorliegende Beitrag vermittelt einen Überblick darüber, welche Erkenntnisse und klinische Erfahrungen es im Hinblick auf die Pharmakotherapie bei stillenden Müttern, insbesondere bezüglich der im Rahmen einer Anästhesie verabreichten Substanzen, gibt.
Abstract
There is no sound information concerning the safe and correct use of analgesics and anesthetics during the lactation period based on studies with a large sample size. Available information is limited to case studies and small sample observations. As a result, information given by the drug manufacturers about the use of drugs during the lactation period is often restrictive or contains contraindications for the lactation period. Although some drugs are not officially licensed for use during lactation they need to be administered in daily (off-label) use. This review gives an overview about the recent knowledge and clinical experience concerning the perioperative use of anesthetics and analgesics during breast feeding.
Literatur
American Academy of Pediatrics Committee On Drugs (2001) Transfer of drugs and other chemicals into human milk. Pediatrics 108:776–789
Andersen LW, Qvist T, Hertz J, Mogensen F (1987) Concentrations of thiopentone in mature breast milk and colostrum following an induction dose. Acta Anaesthesiol Scand 31:30–32
Beilin Y, Bodian CA, Weiser J et al (2005) Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology 103:1211–1217
Benyamini L, Merlob P, Stahl B et al (2005) The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit 27:499–502
Berlin CM Jr (1981) Pharmacologic considerations of drug use in the lactating mother. Obstet Gynecol 58:17S–23S
Berlin CM Jr, Pascuzzi MJ, Yaffe SJ (1980) Excretion of salicylate in human milk. Clin Pharmacol Ther 27:245–246
Berlin CM Jr, Yaffe SJ, Ragni M (1980) Disposition of acetaminophen in milk, saliva, and plasma of lactating women. Pediatr Pharmacol (New York) 1:135–141
Bower S, Hull CJ (1982) Comparative pharmacokinetics of fentanyl and alfentanil. Br J Anaesth 54:871–877
Chang ZM, Heaman MI (2005) Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact 21:305–314 (quiz 315–309, 326)
Datta S, Camann W, Bader A, Vanderburgh L (1995) Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section. Anesthesiology 82:1346–1352
Hale TW (1999) Anesthetic medications in breastfeeding mothers. J Hum Lact 15:185–194
Hale TW, McDonald R, Boger J (2004) Transfer of celecoxib into human milk. J Hum Lact 20:397–403
Ito S, Lee A (2003) Drug excretion into breast milk – overview. Adv Drug Deliv Rev 55:617–627
Jamali F, Keshavarz E (1981) Salicylate excretion in breast milk. Int J Pharm 8:285–290
Kauppila A, Arvela P, Koivisto M et al (1983) Metoclopramide and breast feeding: transfer into milk and the newborn. Eur J Clin Pharmacol 25:819–823
Kranke P (2012) PONV-Prophylaxe in Schwangerschaft und Stillzeit. In: Kranke P, Eberhart L (Hrsg) Übelkeit und Erbrechen in der perioperativen Phase (PONV). Deutscher Ärzteverlag, Köln, S 112–121
Lee JJ, Rubin AP (1993) Breast feeding and anaesthesia. Anaesthesia 48:616–625
Leuschen MP, Wolf LJ, Rayburn WF (1990) Fentanyl excretion in breast milk. Clin Pharm 9:336–337
Madadi P, Ciszkowski C, Gaedigk A et al (2011) Genetic transmission of cytochrome P450 2D6 (CYP2D6) ultrarapid metabolism: implications for breastfeeding women taking codeine. Curr Drug Saf 6:36–39
Madej TH, Strunin L (1987) Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section. Anaesthesia 42:1156–1161
Matheson I, Lunde PK, Bredesen JE (1990) Midazolam and nitrazepam in the maternity ward: milk concentrations and clinical effects. Br J Clin Pharmacol 30:787–793
Nitsun M, Szokol JW, Saleh HJ et al (2006) Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther 79:549–557
Ortega D, Viviand X, Lorec AM et al (1999) Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand 43:394–397
Paech MJ, Salman S, Ilett KF et al (2012) Transfer of parecoxib and its primary active metabolite valdecoxib via transitional breastmilk following intravenous parecoxib use after cesarean delivery: a comparison of naive pooled data analysis and nonlinear mixed-effects modeling. Anesth Analg 114:837–844
Passmore CM, McElnay JC, Rainey EA, D’Arcy PF (1988) Metronidazole excretion in human milk and its effect on the suckling neonate. Br J Clin Pharmacol 26:45–51
Rizzoni G, Furlanut M (1984) Cyanotic crises in a breast-fed infant from mother taking dipyrone. Hum Toxicol 3:505–507
Schaefer C, Spielmann H, Vetter K, Weber-Schöndorfer C (2012) Analgetika, Opiate und Anästhetika. In: Schaefer C, Spielmann H, Vetter K, Weber-Schöndorfer C (Hrsg) Arzneimittel in Schwangerschaft und Stillzeit. Elsevier, München, S 595–613
Seaton S, Reeves M, Mclean S (2007) Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol 47:181–185
Spigset O, Hagg S (2000) Analgesics and breast-feeding: safety considerations. Paediatr Drugs 2:223–238
Todd PA, Sorkin EM (1988) Diclofenac sodium. A reappraisal of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs 35:244–285
Weibert RT, Townsend RJ, Kaiser DG, Naylor AJ (1982) Lack of ibuprofen secretion into human milk. Clin Pharm 1:457–458
Zeisler JA, Gaarder TD, De Mesquita SA (1986) Lidocaine excretion in breast milk. Drug Intell Clin Pharm 20:691–693
Zuppa AA, Sindico P, Orchi C et al (2010) Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci 13:162–174
Zylber-Katz E, Linder N, Granit L, Levy M (1986) Excretion of dipyrone metabolites in human breast milk. Eur J Clin Pharmacol 30:359–361
Einhaltung der ethischen Richtlinien
Interessenkonflikt. C. Nassen, C. Schaefer, J. Wirbelauer, A. Hönig und P. Kranke geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nassen, C., Schaefer, C., Wirbelauer, J. et al. Anästhesie und Analgesie in der Stillperiode. Anaesthesist 63, 415–421 (2014). https://doi.org/10.1007/s00101-014-2311-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00101-014-2311-1
Schlüsselwörter
- Muttermilch
- Säugling, Neugeborenes
- Postoperative Periode
- Halbwertszeit
- Medikamentenassoziierte Begleiterscheinungen und Nebenwirkungen